Ebola raises ethical dilemmas

AUSTRALIA has a moral obligation to do more to assist the people of West Africa dealing with the Ebola crisis, according to infectious diseases experts and the president of the AMA.

In an Ethics and law article published in the MJA, authors from the Centre for Values, Ethics and Law in Medicine and the Marie Bashir Institute for Infectious Diseases and Biosecurity at the University of Sydney wrote that global economic policies and the realities of the free market allowed Ebola to flourish in the poor villages of West Africa. (1)

“The normal drivers of drug research and development — pharmaceutical companies operating in a global marketplace — have failed to develop effective treatments or vaccines for highly virulent and destructive diseases affecting only small numbers of very poor people in sporadic outbreaks”, they wrote.

“Researchers, investors and company directors may recognise humanitarian needs but cannot tolerate the economic risks. Instead, pharmaceutical companies focus on conditions or diseases that involve large markets involving more affluent and regular consumers of their products, where larger profits can be generated.”

In an MJA podcast, Professor Tania Sorrell, director of the Marie Bashir Institute, said that frightening as it seems, the total number of cases of Ebola was small in comparison with, for example, HIV and malaria, making profits for pharmaceutical companies hard to come by. (2)

“On the other side of the coin, this is a disease with high mortality, the affected communities are absolutely decimated by it and I think what we do need to be looking towards is a preventive for the future”, she said.

“I do see a role, particularly for vaccine development. How that will play out in the overall global situation will very much depend on the ability and the willingness of developed countries to help pay for the product and to help its distribution in developing countries.”

Dr Grant Hill-Cawthorne, a lecturer in contagious disease epidemiology at the Marie Bashir Institute and a coauthor of a Perspectives article published in the MJA, said in an MJA podcast that more could, and should, be done. (3)

“Many other countries have given far more and so [we need to think] how Australia can help the West African community”, he said in the podcast.

“We shouldn’t be scared about our country, but we should be scared for those countries that [Ebola has] affected. It’s had a devastating effect on the economies of those countries.

“We should be scared for them and working as a global community to help them.”

The latest update from the WHO reported that 2218 people have died from 4366 cases of Ebola virus disease across Guinea, Liberia, Sierra Leone, Nigeria and Senegal, the worst outbreak of the disease since its discovery in 1976. (4)

Last month, federal Minister for Health Peter Dutton announced the Australian Government would make a $1 million contribution to the WHO towards the ongoing effort to control the Ebola outbreak. (5)

Associate Professor Brian Owler, president of the AMA, suggested last week that the government needed to “show leadership and act immediately”. (6)

“If the Government can get military arms airlifted to northern Iraq at short notice, surely we can airlift medical arms and legs to West Africa just as quickly to save lives”, Professor Owler said.

As a man was cleared of Ebola on Queensland’s Gold Coast last week, both Professor Sorrell and Dr Hill-Cawthorne said Australia was well prepared to deal with any Ebola patient who might arrive on our shores. (7)

The man, in his 20s, was isolated at the Gold Coast University Hospital after developing Ebola-like symptoms following his return from the Democratic Republic of Congo in August, but tests for the virus were negative.

Queensland public health authorities had followed national guidelines and isolated the patient as a precaution, Dr Hill-Cawthorne told MJA InSight.

“The risk to other patients and hospital staff in Australian hospitals is very low due to the good infection control practices that will be carried out”, he said.

2 thoughts on “Ebola raises ethical dilemmas”

Well timed article, as President Obama appears to have bipartisan support for a more comprehensive involvement of the U.S. military in West African EVD mitigation — cross fingers Congress approves this additional $88 million to fund a more scaled-up response. America shows forward looking national leadership. There’s an old outback tale concerning a rich farmer who assisted community/neighbour efforts in fighting a property fire. Federal Minister for Health Peter Dutton’s announcement of a $1 million contribution to the WHO reminds me of this tragic story. Associate Professor Brian Owler, president of the AMA, has stated our government needs to “show leadership and act immediately…” Why no medical airlift? Is it leadership miscomprehension? EVD is bad, but not as serious as an entrenched seasonal disease like malaria which, in 2012, killed 4,026 people in Liberia, Guinea, and Sierra Leone combined? Exponential growth. Spreading at its present one-two from one rate, EVD will infect a significant number of the tweny million in affected countries. Doing little (as we are, obviously), population half-coverage will occur… I believe Aussie politicians should read Greg Laden’s “Has #Ebola Death Toll Surpassed Malaria in West Africa?” http://scienceblogs.com/gregladen/2014/09/11/has-ebola-death-toll-surpas…

The statement that “pharmaceutical companies focus on conditions or diseases that involve large markets involving more affluent and regular consumers of their products, where larger profits can be generated” whilst largely true, is oversimplified and ignores the challenges facing Big-Pharma.

With the average succesful NDA (new drug application) the result of 12-15 years of research and development, costing $1.8 billion, Pharma cannot simply ignore the economics of the industry to devote attention to illnesses such as Ebloa.

In saying that, complex systems produced by the FDA incentivise the development of therapies for orphan diseases. Along with streamlined approval pathways and patent concessions, these methods are a realistic way to promote the development of drugs for illnesses refractory to conventional treatments. However, they require a top down approach with systematic change, something that is often hard to come by. Nonetheless it remains a more pragmatic approach than relying on the moral or ethical motivation of investors and company directors.